Aetna agrees to give refunds to students enrolled in health plan

Posted by Ellen Krafve - email

AUSTIN, TX - Texas Attorney General Greg Abbott has reached an agreement with Aetna Life Insurance Co. that resolves that state's investigation into the insurer's failure to pay college students' out-of-network claims. Under the settlement, an estimated $114,000 will be available to compensate more than 1,200 claims that have been inadequately compensated since 1998.

The agreement stems from a state investigation into Aetna's handling of its college-sponsored student healthcare plans in Texas. The state discovered that Aetna and its affiliate, Chickering Claims Administrators Inc., did not update certain expense-related data, which was used to determine the cost of out-of-network healthcare. As a result, when insured students visited out-of-network physicians or healthcare facilities, Aetna inadequately covered its portion of cost.

Aetna agreed to compensate students or their physicians for underpaid claims that stem from its outdated reimbursement rates. The total value of the settlement, an estimated $114,000, includes penalties and interest. Aetna will contact all affected students or healthcare providers in Texas to inform them about the process for obtaining refunds.

The Aetna health plans in this settlement applied to students enrolled at Rice University, Texas Christian University, Baylor School of Medicine and the University of Dallas.